A randomized, prospective, double-blind comparison of midazolam (Versed) and emulsified diazepam (Dizac) for opioid-based, conscious sedation in endoscopic procedures.
OBJECTIVE
We completed a prospective, randomized, double-blinded clinical trial to compare the quality of sedation with two benzodiazepines (emulsified diazepam and midazolam) for endoscopic procedures.


METHODS
Adult patients undergoing esophagogastroduodenoscopy or colonoscopy were eligible. Exclusion criteria included: drug allergies, altered mental status, untreated glaucoma, active pancreatitis, hyperlipidemia, resident physician training, or cases done outside the Endoscopy unit. Nurses began the sedation process by administering an opioid followed immediately by administering study drugs until patients were adequately sedated. At completion of the procedure, both the physician and the nurse rated whether the patient's sedation appeared to be adequate. In addition, before discharge, patients were asked to rate the quality of sedation.


RESULTS
A total of 111 patients were randomized to the emulsified diazepam group and 100 to the midazolam group. There was no difference in the physician's assessment of quality of sedation between the groups (p > 0.05). The length of time to sedation, total procedure time, and recovery time were similar between both groups. The estimated cost of using emulsified diazepam was approximately 50% less than that of midazolam, with an equal quality of sedation.


CONCLUSIONS
Neither the physicians, nurses, nor the patients could detect a difference between sedation produced by the drugs. We conclude that both drugs were equally effective for sedation for both upper and lower endoscopic procedures. Based on the results of this trial, we suggest that increased use of emulsified diazepam would markedly reduce the cost without altering the quality of sedation. The cost savings would be at least $50,000/yr at our institution.
Van Houten
J S
JS
Department of Pharmacy, Saint Mary's Health Services, Grand Rapids, Michigan 49503, USA.
Crane
S A
SA
Janardan
S K
SK
Wells
K
K
D000328:Adult; D000701:Analgesics, Opioid; D016292:Procedural Sedation; D003975:Diazepam; D004311:Double-Blind Method; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D011446:Prospective Studies
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D003975:Diazepam; D008874:Midazolam